Feb. 24
USA:
Doctors and executions----After 2 refuse to assist a lethal injection in
California, debate over end-of-life ethics grows.
In California this week, two anesthesiologists refused to monitor the
administering of a barbiturate designed to render unconscious convicted
killer Michael Morales before he was to be killed with 2 other drugs. The
execution was called off - or, at least, postponed. Death-penalty
opponents cheered. And the roiling debate over the ethics of medical
professionals' involvement in the officially sanctioned ending of human
life got a little hotter.
At issue: Should a healer help the executioner?
Beyond abortion (where the question of when life begins remains the major
debating point), this includes executions carried out by the state and
physician-assisted suicide now legal in Oregon and being considered in
other states.
Similarly, medical ethics are involved in growing questions about military
doctors taking part in the interrogation of prisoners and the
force-feeding of those on a hunger strike.
In the eyes of most professional medical organizations, physicians have
the ethical and professional obligation to do what they can to make people
well, not to help kill them. The American Medical Association (AMA) code
of ethics states, "A physician, as a member of a profession dedicated to
preserving life when there is hope of doing so, should not be a
participant in a legally authorized execution."
While most states now favor lethal drugs in capital punishment, courts
increasingly are taking a skeptical view of a procedure that critics say
violates the Constitution.
"The issue is whether the method the government has chosen to employ in
our case constitutes cruel and unusual punishment," says Steve Northup, a
Richmond, Va., attorney with a client on death row for gang murders.
"There's a lot of scientific opinion out there to the effect that it
causes a great deal of pain."
In the California case, a federal district judge ordered - for the 1st
time - that licensed medical personnel administer the sedative.
In recent weeks, stays of execution have been granted in 4 cases, and the
US Supreme Court has agreed to hear a Florida case involving lethal
injection.
The California Medical Association has proposed legislation that would end
the role of physicians in capital punishment. In at least a dozen states,
lawmakers are considering proposals that would allow doctors, nurses,
pharmacists, and other medical personnel to become, in effect,
conscientious objectors regarding certain medical treatments.
In Oregon, doctors' involvement in end-of-life treatment focuses on the
nation's only law allowing physician-assisted suicide. The state's 1997
"Death with Dignity Act" specifically prohibits "lethal injection, mercy
killing, or active euthanasia." But doctors may prescribe lethal drugs for
mentally competent adults who declare their intentions in writing and are
diagnosed as terminally ill.
"It's an inherent conflict of interest," says William Toffler, professor
of family medicine at Oregon Health & Science University in Portland.
"It's an inherent degradation of the role of physicians."
That's a concern among some medical personnel in the armed forces, who
worry about doctors in uniform handling of detainees at Guantanamo Bay,
Cuba.
"There is a slippery slope that needs to be addressed," says retired Army
Brig. Gen. Stephen Xenakis, a psychiatrist who once headed one of the
Army's regional medical commands.
Referring to the reportedly harsh treatment of detainees, General Xenakis
told a panel last August, "I don't see that compatible with what we do as
physicians.... There needs to be guidance from the Defense Department that
says that we will not do that, irrespective of what the CIA and the
special ops folks want to do."
In a report to the Army Inspector General last year, Maj. Gen. Lester
Martinez-Lopez, M.D., recommended that military physicians and
psychiatrists not aid interrogators, but that recommendation was rejected
by the Pentagon.
More recently, military doctors have been involved in the force-feeding of
detainees strapped to chairs. Military officials say the treatment remains
relatively humane. And they point out that they, in fact, are preventing
the possible loss of life of prisoners who are on a hunger strike. Critics
disagree.
"If you look at the obligations of the health professions and doctors in
particular, UN standards, World Medical Association standards, AMA
standards, the responsibility of the physician in war or peace is to
improve peoples' health and not to inflict pain or harm," says Leonard
Rubenstein, director of Physicians for Human Rights.
It's important for professionals to abide by their ethical standards, says
Carl Coleman, a law professor specializing in health policy at Seton Hall
Law School. "Part of the nature of a profession is the idea that it's at
least to some extent self-regulating, that there are ideals that may go
beyond the minimum standards the law requires."
(source: Christian Science Monitor)
